Reference no: EM133919722
From the health record of a patient undergoing foot surgery in the outpatient surgical unit.
Indication for Procedure: The patient is a 60-year-old female who has a persistently ingrowing great toenail on the left foot that has had two past infections. The infection is now clear and the patient presents for wedge resection of the toenail. She also has pernicious anemia, Friedreich's ataxia, and heart disease. Because of these conditions, a digital block will be used in the procedure.
Procedure: Wedge Resection of toenail
Procedure Description: The patient is placed in a supine position, with the ones flexed, and the left foot is flat on the table. The toe is prepped and cleansed. A standard digit block is performed with 1 percent lidocaine using a 10 ml syringe and a 30 gauge needle. Approximately 3ml is insulted on each side of the toe.
After waiting 10 minutes, a sterilized rubber band is placed around the base of the toe. The toe is re sterilized and draped with the toe producing. A nail elevator is slid under the cuticle to separate the nail plate from the overlying proximal nail fold. The lateral one fourth of the nail plate is identified as the site for the partial lateral nail removal. A bandage scissors is used to cut from the distal end of the nail straight back beneath the proximal nail fold. A straight, smooth, new lateral edge to the nail plate is created. The lateral piece of the nail is grasped with a hemostat and removed in one piece, pulling straight out.
Electrocautery ablation is used to destroy the nail matrix where the nail was removed. The matrix is treated twice. Antibiotic ointment is applied and a bulky gauze dressing is placed. The foot is placed in a surgical boot. Post-op instructions are given for the daily cleansing with warm water, and strenuous exercise is to be avoided completely for at least one week. The patient tolerated the procedure well and understands the discharge instructions.
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